Saturday, March 24, 2012

You’re invited to celebrate!

What if you allowed yourself to have whatever you wanted to eat? Good cake (my personal favorite), great bread (ok, maybe that’s my real favorite), quality ingredients like aromatic extra virgin olive oil?

What if you allowed yourself to feel like queen or king for the day—every day? Not to shun your responsibilities at work or at home, of course—but to see yourself as special? If you allowed yourself:

  • the power to speak your mind, to ask for what you need?
  • the right to take control of your health?
  • the ability to eat in the presence of others, foods they don’t think you should be eating?
  • the chance to act as if you’re deserving of pleasure—of time for yourself, of adequate nourishment, of enjoying what you’re eating, or getting enough sleep?

Imagine if you thought, if you truly believed that your body is worth taking care of. Then you’d consider the consequences of your actions, when you are thinking about restricting your food intake, or eating despite feeling stuffed, or doing harmful things to your body. Then you might exercise—but not excessively—and you might limit yourself to activities that you really enjoyed.
Imagine if you knew and trusted that there will always be another serving of ice cream tomorrow—that you don’t have to get it all in today. How would that change your thoughts and the amount of ice cream you might eat?

Dear readers, give me a gift today. Take this day— just today to start— to do something nice for your self. Allow yourself to eat something you don’t, in your own mind, believe you’re allowed to eat. Carve out some time, just a wee bit, even, to enjoy your space or to do something you enjoy, just for you.

It’s my birthday today, and I’d like you all to have that gift.
I already eat what I want every day of the year—in amounts that make me comfortable—for the most part. I respect my body—skipping my workout when I’m feeling the need, getting more sleep when my body urges it. Ok, the sleep part’s not always so easy for me! And you probably have learned by now that I don’t struggle much with making my needs known.

So I’m asking for what I want on this birthday. I want to make a difference. I want to feel that something I’ve said has helped you shift your own thinking and change some behavior for the better. I’d love you to treat yourself today—not just on a birthday (if that even happens)—in a way that helps you move forward in your goals.

At least make a wish and set your sights on your direction today!

And please share your experiences in the comments!

Sunday, March 18, 2012

Reaching Your Peak: Guidance to Keep You Moving Forward

My favorite place to hike: Franconia Ridge, NH
I love to hike, but I need to tackle hikes that are achievable. Hike Everest next Friday? That’s crazy! It’s so out of reach for my fitness level, for this time frame, and for my psyche, that I think, “why should I even bother to start training? I’m just not gonna make it”. But if I set realistic goals—attainable heights allowing for modest changes in elevation, I’m golden. Yes, small steps forward really work.

Now if I’m getting a bit fatigued on a hike or even a bit fearful, and I just feel like stopping, I’ve got to consider my options. Is it safe to hover, unprotected, unsupported, ¾ of the way there? Will I be left feeling like a failure because I turned back? Or can I pace myself as I continue up, perhaps accepting less change in elevation each hour, staying the course until I reach my goal? Of course, I have to continue to refuel to enable me to think sensibly about my options!

Gorgeous below, winter conditions at the peak.
Even successful recovery has its surprises.
As I near the peak my pace quickens. And then, at last, I reach it. I can survey the beauty at the top, shifting my perspective. And I can appreciate my achievement.

As for the descent—there are rocky times, to take this analogy further. And for me at least, there are plenty of slips. Truly, I struggle more with the downhill part of my hikes, perhaps due to my fear of falling. But experience proves I can do it. That I can pick myself up and keep moving. 

The view and the feeling from the top make it all worth it all.

“And what does this have to do with me”, you’re wondering?

Stopping Midway On the Weekends

You worked so hard all week, Monday through Friday, staying on track with your eating. For some, this means sticking, more or less, to a meal plan. For others it requires respecting hunger and responding appropriately, distinguishing hunger from a range of other eating triggers.  You pushed past the challenges of social eating. And you countered your unhealthy thinking which leads you astray. You know, the thoughts of “I’ll just get back on track tomorrow” or “So I skip a meal—so what?” Or “What the heck, I’ve already messed up—I may as well keep going since I’ve already blown it!”

So you cut yourself some slack on the weekends. You deserve it, right? What’s a couple of day’s off going to matter? Or maybe you’re just tired of working on your eating, or controlling your activity or your behaviors. As one teen patient expressed, “I’m not about to have this take over my life”, with “this” referring to his time-consuming recovery.

I hated to tell him, but that is absolutely what he needed to do—to have recovery take over his life. Yes, for right now, eating needs to be elevated to the number one priority. In addition to medical appointments, there is nothing more important than focusing on meeting your body’s needs.

You want to be present to assist your kids or an ailing parent? You’ve got to nourish yourself first. You want to feel well physically and take control of your health—to have more energy, to regain your fitness, to prevent a wealth of consequences from a poor diet? (Regardless of what side of the scale you weigh in at). Then you’ve got to shift priorities.

Sure, I know it’s more challenging for most of you on weekends. There’s the lack of structure, the shift in sleep schedule, and the need to be flexible. There’s the social eating, and perhaps drinking. And the fact that everyone’s needs may come first on your days off. Slips will, of course, happen.

But consider the consequence of a bigger slide. Recurring slips on the weekends mean you’ve got to work even harder to get back on track on Monday. View Saturday and Sunday as opportunities to check out, and you will slip into viewing your week in black and white terms; you’ll be eating in two phases—“on track” or “off track”, “in recovery mode” versus “off recovery mode”—far from the moderate sensibility we are striving for.

You’ll feel more discouraged with this repeated process, taking one step forward and two steps back. You’ll continuing to think you’re working so hard, while failing to acknowledge that you’ve lost a lot of ground on your day’s off.

It's a lot easier with support along the way!
There’s no checking out for the weekends. There’s no stopping half way toward recovery, or toward normalizing your relationship with food. It can’t be a 9-5 job. And if you give in to this downward pull, it will only make things more challenging. You’ll have to psyche yourself to start the process again, to begin the climb from the start. You’ll be investing a lot more resources—both time and mental energy. And ultimately, you’ll have a lot more ground to cover!

Really, it’s a lot easier to move slowly to the top, with a few supports along the way.

Thoughts? Please do share!

Monday, March 12, 2012

Protein: The New Black

There’s a halo hanging around all things high protein, these days. In fact, even foods not high in protein are labeled as if they are—simply to convince you to buy them! Case in point: which is lowest in protein— Starbuck’s Protein Bistro Box, Chicken and Hummus Bistro Box or their Turkey and Swiss on wheat bread? 

The winner is? Their Protein Bistro Box! Yes, in spite of containing egg, cheddar cheese and peanut butter—a rather disgusting combination, I might add—it comes out the lowest at 13 grams, compared to its competitors at 16 grams and 34 grams of protein, respectively. 

If you are selecting the Protein Bistro because you think all that protein (which doesn’t exist anyway) is going to help with weight management, let me break the news—it’s among their higher calorie meals! And for the record, it's the calories that make the difference. Personally, I’d rather have the lower cal sandwich and add on a mini whoopee pie or cupcake. Maybe that’s just me.

I could have kept this secret to myself. I mean, if you are underweight and struggling to eat more, and protein feels safe, what’s it to me? But here’s the thing. I believe you need to be well informed, that if you are striving to eat better you should have the facts. That goes for those of you who are trying to increase your intake and gain some weight, and it applies to everyone else too. If you are overweight and struggling to lose weight, it’s only fair that you, too, be well-informed. Being well-informed, well-equipped to handle misinformation, allows you to be in control.

So let me set the record straight—there’s nothing magical about protein, about any one nutrient, in fact, that’s going to resolve your weight struggle. And we don’t eat protein. Rather, we eat foods, not nutrients. In those foods there may be protein, but there will also be other macro (large) nutrients, such as fats or carbohydrate. If you assume that protein is good, or safe, it implies that carbs and fats are bad. And you know what I think about these descriptions of good and bad! We need all three macronutrients for health. And no one nutrient will cause weight gain—or weight loss. If only it were that simple.

Adequate protein intake without adequate total calories will still result in loss of muscle mass. Not a good thing! Loss of muscle mass decreases metabolic rate, necessitating fewer calories to maintain your weight.

Excess calories over and above your need for maintenance, regardless of their source—protein, fat, or carbohydrate—will help contribute to an increase in weight.

Yes, it really is about energy balance.

Take it from Harriet

Harriet, an overweight woman, came to see me last week for guidance on weight loss. She’d been working with a trainer recently, at her gym. And given his extensive training in nutritional science (you know, men’s work out magazines and the like) he guided her to do the following: eat virtually no carbs, but push protein—you know, to build muscle and increase metabolism. She was eating as he instructed, whole avocados without the crackers, and limiting her fruit to only grapefruits (3 times per day). Reminds me of the Scarsdale Diet I followed in my teens for no good reason and with no good outcome!

Her energy level plummeted, making her workouts quite the challenge. She reported feeling deprived following her current regimen, and she spent a great deal of time thinking about food, preoccupied with when and what she’d get to eat next. And so she wisely sought out more sensible guidance.

When she presented at her initial session with me, she left with a grin from ear to ear. “Now I can have starches? And other fruits?” She was so excited. At her one week follow up visit, she reported feeling great—greater energy, and so much happier, being able to enjoy foods she badly missed. And, her weight was down. In fact, I had to recommend she further increase her intake to slow the rate of weight loss. It certainly proved the point that carbs weren’t harmful, and large amounts of protein are hardly helpful!

Regardless of your eating struggles, trust that all nutrients are necessary, and safe to eat. Be flexible, to avoid deprivation, allowing you to sustain healthy dietary changes. And please don’t be misled by poorly trained trainers, or misleading food packaging! 

Monday, March 5, 2012

Are You Still Thinking It’s All About Your Weight?

You’re a mixed crowd, dear readers. You are patients, current and past, local and those I Skype with overseas. And you are Anonymous followers whose identity I’ll never know. You are largely female, but include many a loyal male reader. You cover most ages from late teens to into your 70s. On a recent day you visited from all 50 US states (a first!). And you regularly read from all continents. 

I love this! 
I certainly don’t know you well, except for what you share in your comments and emails. You may struggle with an eating disorder of any variety or strive to maintain your sanity in a world of over focus on food rules and misinformation.

You may be underweight or overweight—whatever those terms have come to mean—and you may or may not have come to terms with the work that needs to be done. You may be simply contemplating change or you may be working on maintenance and relapse management.

Yet here’s one thing I know for sure: your weight is not a valid measure of your progress nor of your effort, of your commitment to change or your need for change.

The past couple of weeks I’ve had many an encounter that convinced me I needed to share these thoughts with you.

Here’s a sampling of what I heard this week:

  • She was frustrated by her stabilized weight—it was nothing like those weight loss ads promise! Yet she realized that she is now capable of eating a couple of Oreo cookies. Just a couple—and feeling satisfied. And, she was able to talk about it, as opposed to keeping this info a secret. No more Oreos in the closet.
  • There was the realization that food tastes good! From someone who has spent the past umpteen years eating while barely using her senses (similar to how she was living life) this was a giant accomplishment. She now appreciates what she likes, and can follow her preferences. And she can allow herself this pleasure long denied.
  • “Do you mind if I eat in our session?” she asked me, as she nonchalantly pulled out her McDonald’s French fries. “I haven’t had time for lunch yet”. Long ago when we started our work together, reliance on a meal plan was absolute and deviating from the plan was a non-option. Food was restricted and binging was common. Think what you might about fast food, seeing this meal enjoyed, and eaten normally, made me happier than I’ve ever imagined a McMeal might!
  • He is learning to reframe his actions. Instead of, “I only walked 3 times this week, for only 10 minutes”, I can, with a mere raise of an eyebrow have him shift his focus. “I walked three times this week! I’ve started to make walking a priority to help my blood sugar! And it’s feeling good.”
  • Black and white thinkers may still struggle with what I refer to as the what the heck effect, that sense of why bother I’ve already ruined it. Yet even their acknowledgement that the thinking is the culprit, not the food item, is a major and necessary shift.
  • And finally there was this list I received from Dana just yesterday:

First I'd like to begin with the positive changes I have made since under your care:

    -I'm not starving myself
    -I'm throwing up TONS less
    -I do NOT exercise, ever
    -I incorporate risk foods into my diet
    -ed thoughts no longer consume 100% of my brain
    -buffets are "manageable"
    -I allow myself to eat after dinner
    -I no longer consume bottles and bottles of diet coke/day, just 1 or 2 glasses
    -I only drink 2 cups of coffee/day - not 2 pots
    -I DRINK calories!!!!!!!!
    -I allow myself to snack in between meals
    -I can go to dinner with my friends now with very little anxiety
    -I eat in front of people with more ease
    -I can control binges with much greater power
    -I recognize and honor my hunger now
    -I have learned to speak up a little more
    -I am present
 I know there's a LOT more to that list, but those were the ones at the top of my head.

Proud Tiger Mom and her cub, taking her
French pastries home after a satisfying brunch.

I feel like a proud Tiger Mom. Really.

In each of these cases, focusing on weight as the end point would have been absurd. In Dana’s case, weight has been around the same for probably a year. Why probably? Because honestly I rarely obtain it. But the times I do, it never surprises me. I’m not blindsided by positive talk without substance. And I ensure my patients are following up with their physicians for medical checks when necessary.

Weight can be stable or in a normal range while binging and purging. It can be stable while restricting followed by rebound overeating. And weight can be outside the “healthy” BMI range with either healthy or unhealthy diet and behaviors. What a disaster it would be then to focus on weight without attention to the damaging behaviors!

Just the setting for enjoying a pastry out!
Weight assessment certainly has its place. A progressive shift in an unhealthy direction (for an individual’s need) is clearly a red flag. But without assessing the underlying thoughts as well as the behaviors, obtaining and focusing on weight is nothing short of damaging.

I'd love to hear how your thoughts and actions have shifted, so please share!